In the DSM-5, part of, and listed under Sensory Interests, is Self-Injurious Behavior (SIB). Thompson (2012) states that the most common emergent forms of self-injury are finger, hand, and wrist biting and hitting head with fists or against hard surfaces. Once self-injury becomes entrenched behavior, it is often difficult to eliminate.

A parent reports that there were periods that her son struck his head so hard and so often, it caused severe bruising on the back of his head. His only form of communication, as soon as she gave him what he wanted he stopped.

Often SIBS are found to be included in ‘Challenging Behavior’, or ‘Behavioral Disturbances’ instead of a stand-alone sensory issue. Soke et al. (2017) the reasons may be that studies find both environmental and biological factors have been implicated in studies of SIBs since 1977.

These authors say that generally SIBs are difficult to manage and may result in hospitalizations, exclusion from educational or vocational activities, admission to residential facilities, and even in death. They believe that previous studies are lacking and SIBs have been associated with everything from maternal smoking, sensory issues, gastrointestinal problems, aggression, insomnia, age and gender, severity of co-morbid behaviors; and everything in between.

Chezan et al. (2017) claim that SIBs is a relatively common problem behavior among children with Autism Spectrum Disorder (ASD). This review covers a broad category of problem behaviors, including verbal and physical aggression, property destruction, and tantrums. Severe SIBs require an intervention that is both effective and efficient.

Without effective interventions, they say, it can have a negative impact on children’s quality of life, limiting development and even leading to health-related problems. Interventions have the potential to prevent or reduce the frequency and severity of SIB, but if allowed to persist across time may continue until adolescence and adulthood.

Sicile-Kira (2014) thinks that some children with autism participate in self-aggressive behavior because they could be in pain and don’t have any other way of communication this. She also has seen ASD persons self-injuring in the throes of a PTSD flashback.

She defines SIBs as hitting, biting, head banging, flicking fingers, or slapping oneself as a possible method of sensory seeking stimulation to relieve anxiety, pain, or frustration. Others believe that there is something missing in their diet or something they are getting in their diet that they should avoid.

Those lacking stimulation from their environment may seek it through self-abuse. Some self-abuse is in response to smells, being touched, auditory and visual overstimulation or under-stimulation. Still others believe medication can be found to counteract symptoms.

< My Thoughts > “Others believe medication can be found to counteract symptoms.”

Some of the things that Sonny does, as a result of his autism, is self-injurious behavior (SIBs). With him, this seems to be compulsive, ritualistic, and some sort of stimulation or communication. This was before finding a method of communication and a therapeutic dosage of medication to help him, too. He would strike out to bite or hit himself and others. He would stick a finger in his eye, poking and poking until restrained. When Sonny is under medicated, stressed, and/or can’t get what he wants he will tantrum and bite himself until his needs are satisfied.

He has other undesirable and even dangerous behaviors, which I will not go into here. I’m sure you get the idea of how frightening this can be. The caveat with Sonny is that as well as sad or mad, he can and will often do this self-injurious behavior as a result of being happy and excited about something he’s thinking about or doing. So first, we must stop the risky behavior and then try to find out why. Smiles.

Bogdashina & Casanova (2016) believe self-stimulating behaviors can occur when autistic children are seeking control of their Autonomic Nervous System. One intervention can be a desensitization intervention of the affected areas performed by a qualified and experienced therapist. Another intervention can be exploring deep pressure, squeezing by cushions, or a weighted blanket may help.

They say that when excessive aggression, anxiety meltdowns and panic attacks occur, physical exercise like swinging, climbing, or pushing heavy objects relieve some people. Self-monitoring behavior and other coping mechanisms can be taught for less severe cases of SIBs, to help your child feel safe, trusting their environment.

Sarris (2012) tells parents that early symptoms of autism may be among the most puzzling. Some are barely noticeable, such as response to lights, heat, cold, or physical discomfort. Using their hands or body to manipulate things is not always seen as problematic behaviors.

< My Thoughts > “Some are barely noticeable…”

Sometimes the sensory response causing the self-injurious behavior is an attempt to fix what’s wrong. But often, they don’t know what is wrong or how to fix it. A child who bites themselves because they are too hot or too cold, doesn’t know that putting on or taking off a sweater can make them more comfortable. Of course, trying to get a sweater on or off, may be a challenge of its own! Sonny just reacts as if there is some sort of task assignment taking place. Smiles.

Sarris (2015) cautions that self-injury can persist into adolescence. Violent episodes of challenging repetitive behavior can lead to cuts, bruises, dental problems, and even broken bones, concussions, and detached retinas. She tells how frightening this is because it seems to violate our basic instinct of self-preservation. Those parents are deeply challenged to protect their offspring. They childproof their homes, buckle their seat belts, walk them to school, shielding them from outside harm. But she questions how they can protect them from themselves?

Wright (2018) believes that a behavior consultant is able to offer new insight for the entire family to digest and begin to shift the perspective needed to track and record behavior. An example would be – The family is concerned that Johnny seems to be an aggressive child, frequently hitting those in his environment. Through BEHCA data collection the behavior consultant is able to find that Johnny is NOT doing this on purpose but as a sensory response to his environment. He is also NOT aware of how hard he is hitting.

Taking this further, she says that perhaps Johnny’s behavior is due to his NOT knowing what his body is doing. He is lacking spatial awareness. Or, by slamming his body/arms into things or people, he is seeking sensory input. But, he is NOT intentionally trying to hurt anyone.READ MORE - Click Here =>

< My Thoughts > “He is not intentionally trying to hurt anyone.”Now, when the behaviorist shares this information with family and teachers, they can see that Johnny is NOT an aggressive child. Johnny is engaging with his environment in the only way he knows how to, in order to satisfy his sensory needs. Note: Created by Torri Wright, “BEHCA is a software application specific to collecting and analyzing data, it has the function to become a virtual communication among multiple environments. BEHCA can be used as a communication tool from one environment to another for a variety of providers within various settings; can also be viewed by support people.”REFERENCES used here are: Bogdashina, O. & Casanova (2016). Sensory Perceptual Issues in Autism and Asperger Syndrome, Different Sensory Experiences – Different Perceptual Worlds; Second Edition: London; Philadelphia: Jessica Kingsley Publishers.Chezan, L., Gable, R., McWhorter, G., White, S. (2017). Current Perspectives on Interventions for Self-Injurious Behavior of Children with Autism Spectrum Disorder: A Systematic Review of the Literature; Journal of Behavioral Education; V26, p 293-329.Kraper, C., Kenworthy, L., et al. (2017). The Gap Between Adaptive Behavior & Intelligence in Autism Persists into Young Adulthood & is Linked to Psychiatric Comorbidities; Journal of Autism Developmental Disorders; V47, p3007–3017.Sarris, M. (2012). Behaviors that Puzzle: Repetitive Motions & Obsessive interests in Autism; Retrieved from online at – https://iancommunity.org/cs/challenging_behaviors/repetitive_motions_and_obsessions.Sicile-Kira, C. (2014). Autism Spectrum Disorder (revised): The Complete Guide to Understanding Autism; New York, New York: Penguin Random House Company.Soke, G., Rosenberg, S., Hamman, R., et al. (2017). Factors Associated with Self-Injurious Behaviors in Children with Autism Spectrum Disorder: Findings from Two Large National Samples; Journal of Autism Developmental Disorders; V47, p285–296.Thompson, T. (2012). Making Sense of Autism; Second Edition. Baltimore, Maryland: Brookes Publishing Company.Wright, T. 2018). See Beyond Behavior: BEHCA: a Method for Understanding & Influencing Behavior Change; behca.com.Zachor, D. & Ben-Itzchak, E. (2014). The Relationship Between Clinical Presentation and Unusual Sensory Interests in Autism Spectrum Disorders: A Preliminary Investigation; Journal of Autism Developmental Disorders; V44, p229–235.===============Note: NEXT BLOG #5H SENSORY CATEGORIES===============< My Thoughts > What I am offering here is a powerful story which may capture in a moment, what it is like to have this experience.Paula’s Journal: Surviving Autism by Stephanie R. Marks, eBooks 2012 Edition; with < My Thoughts > by Sara Luker

Focused Excerpts from the book (17% indicates location in the Kindle version of the book, instead of page numbers.)

17% A Day – Well, there are times when I will scratch and scratch until I break the skin. It feels good at first and then it starts to hurt.< My Thoughts > “Self-stimulation, leading to Self-Injurious Behavior…” According to Rattaz et al. (2015) studies show that (Self-Injurious Behavior) “SIB were frequently associated with other challenging behaviors… irritability, stereotypy, hyperactivity, and impulsivity.”They go on to say that “…abnormal sensory processing was also found to be a strong predictor of self-injury, as well as impaired social functioning.” This group wanted to find out if there was a difference between the kinds and the frequency of SIB and risk factors. Their study found that “there was no difference” between risk factors in regards to gender of associated medical conditions, such as epilepsy, in association with SIBs. And, no significant differences in frequency of SIB and risk factors when considering environmental factors such as parents’ socio-economic status or weekly total intervention time spent.< My Thoughts > “…associated medical conditions, such as epilepsy…”We now know that with Sonny, it could be he’s in the throes of a seizure, because unless it’s a ‘breakthrough’ seizure, we can’t always determine that he is seizing. Then, if he does remember what happened, falling down or dropping, he quickly looks around to see who did it! His reaction then is to retaliate, coming after you with teeth and or claws ready. Just so you know, the Epilepsy Foundation tells us about the seizures that you may not recognize or realize are happening –

Fumbling (suddenly losing connection between brain and intended action, can also look like a type of stimming)

Wandering (again, losing focus or purpose and just meandering off to parts unknown)

Shaking (having tremors, may seem like a cold chill, or ongoing and uncontrollable shakes)

Confused speech (trying to stay in the moment, but unable to stay connected or focused with their thoughts)

Retrieved from: www.epilepsyfoundation.orgRecent studies like Rattaz, include Oliver & Richards (2015) study which encourages determining risk factors for SIB, in order to start early intervention. When targeted early, even before self-injurious behavior begins, the severity of the behavior can be controlled. Studies showed that discovering early SIB markers, along with physical health assessments and vigilance for discovering emerging behaviors were crucial. Seemingly, there was a higher correlation between a high Childhood Autism Rating Scale (CARS) scores with a higher risk of SIB during adolescence. They also found SIBs linked to impulsivity, overactivity and the high-frequency of repetitive behaviors.17% When I was small, I would bang my head and bang my head. I know there are lots of theories about self stimulation. Why choose to use self stimulation with an action that hurts? Someone out there help me to understand. At first it feels good and then it starts to hurt. Self-stimulation – why would someone choose to do an action which hurts? Someone out there help me to understand. Someone who feels the same way I do, not someone with a theory. Click clack. Click clack. Click clack.< My Thoughts > “Someone out there help me to understand.” My thinking is that self-stimulation is in response to something else that is going on, either in the environment or within the person. Along with the strong impulse to ‘do something’, the self-stimulation may happen to offset an internal pain or ‘perceived pain’ that the person is experiencing. Sequira & Ahmed (2012), see meditation as a way to respond to unwanted self-stimulation. They believe that “meditation is one of a few interventions that have been shown to effectively strengthen self-control, improve cognitive and behavioral performance.” They cite a few studies which have “reported these benefits; the mantra “Om” has been shown to synchronize respiratory signals, cardiovascular rhythms, and cerebral blood flow while another mantra, “SaTaNaMa,” was reported to significantly change cerebral blood flow.”Wolff, et al. (2016) published parts of a questionnaire to rate repetitive behavior in early childhood. This may help identify children who are at-risk for having or engaging in SIBs. Here are the some of the topics noted –

Restricted interests & behavior

Ritualistic & routine behavior

Motor stereotypy & repetitiveness

Repetitive & self-directed behavior

Finding some of these clues can be said to determine precursors to SIBs. Parent interviews, questionnaires, and observational measures are still some of the only acceptable ways to identify cases of SIBs.

REFERENCES used here are:

Rattaz, C., Michelon, C., Baghdadli, A. (2015). Symptom Severity as a Risk Factor for Self-Injurious Behaviors in Adolescents with Autism Spectrum Disorders; Journal of Intellectual Disability Research; V59, p730-741.Sequira, S. & Ahmed, M. (2012). Meditation as a Potential Therapy for Autism: A Review; Autism Research &Treatment; published online- https://www.ncbi.nlm.nih.gov/pubmed/22937260.Wolff, J., Boyd, B., & Elison, J. (2016). A Quantitative Measure of Restricted & Repetitive Behaviors for Early Childhood; Journal of Neurodevelopmental Disorders; V8:27.===============< My Thoughts > What I am offering here is a powerful story which may capture in a moment, what it is like to have this experience.

A Spot on the Wall, by Martha Squaresky; eBook 2014 Edition;with < My Thoughts > by Sara Luker Focused Excerpts from the book (85% indicates location in the Kindle version of the book, instead of page numbers.)85% Greg’s fingers showed evidence of his own personal attacks. For years during tantrums, he bit his fingers. Calluses built up to the point that when we held his hand, we felt the hard spots on each side of his index fingers.To better understand why Greg exhibited this self-injurious behavior, I compared it to cutting. Cutters seek a release from the emotional pain that they are experiencing, and may cut on impulse.Greg felt better when he bit his fingers. Maybe there was a release of endorphins that brought relief from whatever was causing Greg’s tantrums, thus making it a compulsive behavior. In many ways his puking mirrored cutting.I wanted him to find peace from his personal demons. End of excerpt fromA Spot on the Wall, by Martha Squaresky.

< My Thoughts > “…his personal demons.”Discovering his personal demons. Self-injury behavior can be connected or related to other behavior symptoms. Richards, et al. (2015) looked at studies which examined possible links between punitive associations and self-injury. Studies included both child and adult participants. There were more males in the child samples and higher levels of Repetitive Restricted Behavior (RRB) in the adult samples; with no significant differences between groups with high levels of Overactive/Impulsive behavior.They felt that in adulthood the presence of self-injurious behavior (SIB) predicted the presence of self-restraint. The types of (SIB) they saw was hitting, biting, pulling, scratching, or rubbing self. Some even began cutting self, bending fingers or inserting them into parts of face.According to Richards, self-restraint was seen as a coping mechanism in those with higher-intellectual disability autism. Self-restraint seemed to come into play as a functional behavior rather than a control. The types of self-restraint found were behaviors like wrapping self in own clothing, holding onto self, squeezing objects, or positioning self so as to be restrained.Ruzzano, et al. (2015) looked at a study with a goal of considering symptom connections such as the relationship between autism and Obsessive Compulsive Disorder (OCD). This study found a rich variety of disorder symptoms which seemed to be related. These were –

Things which may have touched dirt causing compulsive ‘washing’ symptoms.

Certain types of clothing causing stereotypical behavior.

Saying specific phrases in a certain way requiring them to be said at a certain time.

The study found that one symptom may create or cause another symptom. And, that the symptom connections were not random and could vary in strength. An example given was that concern with something touching dirt may cause the symptom of constant hand-washing. Also, saying that these symptoms can result in sensory auditory, tactile, visual, or multisensory overload. In addition, they found that some persons had thoughts of doing something bad, due to a ‘higher’ powers insistence. They did not elaborate on this symptom connection.

< My Thoughts > “…symptom connections…”

With Sonny, how we see this connected to SIB behavior is that when he’s prevented from obsessing on whatever, he will immediately bit himself or head bang; overriding any medication he’s taking.Some of the medication that Sonny takes is also given for persons with OCD. We know he has autism, but we don’t know for certain if he has OCD. Maybe there is a slight ‘overlap’ because there are those ‘constant checking’ days which we call ‘inventory days’, or Sonny getting out all of his toys, books, cards, etc. from the shelves and cupboards.

He doesn’t always play with them, but just wants to know they are still there. At times, he lines them up on the bed and on the floor, often stretching into nearby rooms. Then there’s the daily ‘checking’ of the cupboards and refrigerator. This is for his favorite foods, drink and cups. We have to be on ‘stand-by’ because if he doesn’t see what he expects, or if he perceives something is missing… all ‘heck’ breaks loose, as they say. Smiles.

REFERENCES used here are:Richards, C., Davies, L., Oliver, C. (2017). Predictors of Self-Injurious Behavior & Self-Restraint in Autism Spectrum Disorder: Towards a Hypothesis of Impaired Behavioral Control; Journal of Autism Developmental Disorders; V47, p701–713.Ruzzano, L., Borshoom, D., Geurts, H. (2015). Repetitive Behaviors in Autism & Obsessive-Compulsive disorder: New Perspectives from a Network Analysis; Journal of Autism Developmental Disorders; V45, p192–202.===============< My Thoughts > What I am offering here is a powerful story which may capture in a moment, what it is like to have this experience.

MIRACLES ARE MADE: A Real-Life Guide to Autism, by Lynette Louise, and eBook 2011 Edition: with < My Thoughts > by Sara Luker

Focused Excerpts from the book (13% indicates location in the Kindle version of the book, instead of page numbers)

17% Bo was a beautiful black baby only four years old. But when I met him he was a fast enough scratching, biting, leaping little dynamo to have created fear and permanent scarring in al his parents’ friends and family. I used neurofeedback to calm his overactive sensory motor strip, and by Sunday Bo was calm. We had to teach him that swallowing his food didn’t have to happen in gulps wherein he put his fists down his throat and made himself vomit. His sensory system was awash with challenges, but by day five he had responded.Note: the brain’s sensory motor strip (primary frontal cortex of the brain) receives, sends and organizes incoming sensory information, in order to control voluntary movement of the skeletal muscles; including things like swallowing, speech, taste, and smell.====================

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My purposes are 'educational' in nature. My hope is that this is a place for 'First Responders' and the 'Battle Worn' alike to find information, take solace, and to help one another, in the name of Autism. My commitment is to deliver hope, insight, and a realm of possibilities to all who enter this site.

​Disclaimer: Just to let you know that I, Sara Luker, have put forth my best efforts to create the extended book reviews presented here on this website. I have permission from the authors to publish these Extended Book Reviews. This is just a sharing of stories of those who have gone on before you.

My input as noted by <My Thoughts> are just that... my reflections as a parent, educator, and author. The ideas or considerations presented are given only as hopefully helpful to the viewers relating to the topic or subject.

Any REFERENCES to websites, professional journals, and/or printed material, including eBooks, are solely for educational purposes. I have no involvement in sponsorship or financial interests in these sources.

​Please, understand also that all health matters ALWAYS require professional medical decisions, diagnosis, and treatment by highly qualified and licensed individuals.​Regards,Sara Luker